The Consequences of an Abdominal Aortic Aneurysm Infected with Methicillin-resistant Staphylococcus aureus (MRSA)

Introduction were all positive for MRSA thus the patient was commenced on teicoplanin. An ultrasound demonstrated Infection of the material lining an atherosclerotic abshrunken kidneys and a 6.7 cm diameter AAA. A CT dominal aortic aneurysm (AAA) is generally a conscan demonstrated an infrarenal AAA with a contained sequence of systemic bacteraemia or septicaemia. leak anterior to the right psoas muscle and a reCulture of AAA contents is frequently positive, howtroduodenal ‘‘collection’’ (Figure 1). At laparotomy, ever, the infecting organisms are generally of low the aneurysm was found to communicate with the virulence. Methicillin-resistant strains of Staphycontained leak and the retroduodenal mass (a large, lococcus aureus (MRSA) were first described in the U.K. pus-filled cavity which subsequently grew MRSA). in 1961, and are now a major cause of nosocomial The aortic stump was over sewn (2 layers of 0/0 infection. We report the consequences of an infra renal prolene) and covered with sac, peritoneum and omenAAA infected with MRSA. tum. Following laparotomy closure, a complete change of instruments and gowns, the patient was re-draped and a right axillo-bifemoral rifampicin soaked Gelsoft (Vascutek) graft was inserted. The left subclavian Case Report dialysis catheter was removed. The patient was discharged home on the 14th post A 65-year old man presented with a 3-week history operative day, dialysed via a left internal jugular cathof acute onset, constant low back pain and a 4-day eter inserted on the second postoperative day and history lethargy, reduced appetite and night sweats. receiving intravenous vancomycin titrated according Relevant past history included chronic renal failure to plasma levels. requiring haemodialysis for the preceding 6 months, Three weeks following discharge the patient previa a left subclavian catheter. He was known to have sented with collapse, haematemesis and fresh PR a small AAA (AP diameter 3.5 cm on ultrasound 2 bleeding. A CT suggested a fistula between the jejunum months earlier) and previously had undergone biand the aortic stump, which was confirmed at laplateral iliac angioplasties for claudication. On exarotomy, where the fistula was taken down, the aortic amination, he was apyrexial and haemodynamically defect repaired with 3/0 prolene and the jejunum stable with a tender right-sided abdominal mass and repaired with 2 layers of 3/0 vicryl and an omental reduced femoral pulses. Throat, nasal, axillary and groin swabs, central and peripheral blood cultures patch. The distal suture line was intact. The aneurysm cavity was packed with a haemostatic Gentamicin impregnated pad (Collatemp G) and closed. Eight ∗ Please address all correspondence to: I. C. Chetter, Academic hours later, the patient suddenly became profoundly Vascular Unit, Vascular Laboratory, Alderson House, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, U.K. hypotensive, tachycardic and distended. He developed